Abstract

Information on the micronutrient quality of alternative weight-loss diets is limited, despite the significant public health relevance.Micronutrient intake was compared between overweight or obese women randomly assigned to 4 popular diets that varied primarily in macronutrient distribution.Dietary data were collected from women in the Atkins (n = 73), Zone (n = 73), LEARN (Lifestyle, Exercise, Attitudes, Relationships, Nutrition) (n = 73), and Ornish (n = 72) diet groups by using 3-d, unannounced 24-h recalls at baseline and after 8 wk of instruction. Nutrient intakes were compared between groups at 8 wk and within groups for 8-wk changes in risk of micronutrient inadequacy.At 8 wk, significant differences were observed between groups for all macronutrients and for many micronutrients (P < 0.0001). Energy intake decreased from baseline in all 4 groups but was similar between groups. At 8 wk, a significant proportion of individuals shifted to intakes associated with risk of inadequacy (P < 0.05) in the Atkins group for thiamine, folic acid, vitamin C, iron, and magnesium; in the LEARN group for vitamin E, thiamine, and magnesium; and in the Ornish group for vitamins E and B-12 and zinc. In contrast, for the Zone group, the risk of inadequacy significantly decreased for vitamins A, E, K, and C (P < 0.05), and no significant increases in risk of inadequacy were observed for other micronutrients.Weight-loss diets that focus on macronutrient composition should attend to the overall quality of the diet, including the adequacy of micronutrient intakes. Concerning calorie-restricted diets, there may be a micronutrient advantage to diets providing moderately low carbohydrate amounts and that contain nutrient-dense foods.

Abstract

This paper presents a new, comprehensive tool for communities to assess opportunities for active living and healthy eating and to mobilize all sectors of society to conquer obesity and chronic disease.Relevant existing tools and input from an expert panel were considered to draft the Community Healthy Living Index (CHLI). CHLI covers five major sectors where people live, work, learn, and play: schools, afterschools, work sites, neighborhoods, and the community-at-large. CHLI and the accompanying procedures enable community teams to assess programs, the physical environment, and policies related to healthy living and to plan improvement strategies. In 2008, with local YMCAs acting as conveners, community assessment teams from six US communities pilot-tested CHLI for cognitive response testing, inter-rater reliability, and implementation feasibility. CHLI was revised to reflect the test results.Pilot analyses demonstrated that the process was feasible, with most questions being interpreted as intended and showing substantial to almost perfect agreement between raters. The final CHLI is being disseminated nationally.Preliminary data illustrate CHLI obtains reliable results and is feasible to implement. CHLI is a promising tool for community-based prevention efforts to draw attention to opportunities for healthy living and create impetus for community changes.

Abstract

To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income =100% of federal poverty level [FPL]) and 20% near-poor (101-200% FPL); and around 60% of low-income (poor or near-poor) women experienced at least one hardship. While hardship prevalence decreased significantly as income increased, many non-low-income women also experienced hardships; e.g., in California, 43% of all women and 13% with incomes >400% FPL experienced one or more hardships. These findings paint a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.

Abstract

Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce.We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success.Secondary analysis was performed using data from 181 free-living overweight/obese women (mean+/-s.d. age=43+/-5 years, body mass index=31+/-4 kg m(-2)) participating in a 1-year randomized clinical trial (the A TO Z study) comparing popular weight loss diets (Atkins, Zone and Ornish). Participants' dietary adherence was assessed as the difference between their respective assigned diet's recommended macronutrient goals and their self-reported intake. Association between dietary adherence and 12-month weight change was computed using Spearman's correlations. Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests.Within each diet group, adherence score was significantly correlated with 12-month weight change (Atkins, r(s)=0.42, P=0.0003; Zone, r(s)=0.34, P=0.009 and Ornish, r(s)=0.38, P=0.004). Twelve-month weight change in the most vs least adherent tertiles, respectively, was -8.3+/-5.6 vs -1.9+/-5.8 kg, P=0.0006 (Atkins); -3.7+/-6.3 vs -0.4+/-6.8 kg, P=0.12 (Zone) and -6.5+/-6.8 vs -1.7+/-7.9 kg, P=0.06 (Ornish).Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

Abstract

Income data are often missing for substantial proportions of survey participants and these records are often dropped from analyses. To explore the implications of excluding records with missing income, we examined characteristics of survey participants with and without income information.Using statewide population-based postpartum survey data from the California Maternal and Infant Health Assessment, we compared the age, education, parity, marital status, timely prenatal care initiation, and neighborhood poverty characteristics of women with and without reported income data, overall, and by race/ethnicity/nativity.Overall, compared with respondents who reported income, respondents with missing income information generally appeared younger, less educated, and of lower parity. They were more likely to be unmarried, to have received delayed or no prenatal care, and to reside in poor neighborhoods; and they generally appeared more similar to lower- than higher-income women. However, the patterns appeared to vary by racial/ethnic/nativity group. For example, among U.S.-born African American women, the characteristics of the missing-income group were generally similar to those of low-income women, while European American women with missing income information more closely resembled their moderate-income counterparts.Respondents with missing income information may not be a random subset of population-based survey participants and may differ on other relevant sociodemographic characteristics. Before deciding how to deal analytically with missing income information, researchers should examine relevant characteristics and consider how different approaches could affect study findings. Particularly for ethnically diverse populations, we recommend including a missing income category or employing multiple-imputation techniques rather than excluding those records.

Abstract

To determine whether socioeconomic and food-related physical characteristics of the neighbourhood are associated with body mass index (BMI; kg/m(2)) independently of individual-level sociodemographic and behavioural characteristics. Design andObservational study using (1) individual-level data previously gathered in five cross-sectional surveys conducted by the Stanford Heart Disease Prevention Program between 1979 and 1990 and (2) neighbourhood-level data from (a) the census to describe socioeconomic characteristics and (b) data obtained from government and commercial sources to describe exposure to different types of retail food stores as measured by store proximity, and count of stores per square mile. Data were analysed using multilevel modelling procedures. The setting was 82 neighbourhoods in agricultural regions of California.7595 adults, aged 25-74 years.After adjusting for age, gender, ethnicity, individual-level socioeconomic status, smoking, physical activity and nutrition knowledge, it was found that (1) adults who lived in low socioeconomic neighbourhoods had a higher mean BMI than adults who lived in high socioeconomic neighbourhoods; (2) higher neighbourhood density of small grocery stores was associated with higher BMI among women; and (3) closer proximity to chain supermarkets was associated with higher BMI among women.Living in low socioeconomic neighbourhoods, and in environments where healthy food is not readily available, is found to be associated with increased obesity risk. Unlike other studies which examined populations in other parts of the US, a positive association between living close to supermarkets and reduced obesity risk was not found in this study. A better understanding of the mechanisms by which neighbourhood physical characteristics influence obesity risk is needed.

Abstract

Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P

Abstract

Most studies that have focused on the costs of obesity have ignored the direct effects of obesity-related patterns of diet and physical activity. This study reviews the full effects of each component--poor dietary and physical activity patterns and obesity--on morbidity, mortality and productivity. The direct healthcare costs are based on a review of the effects of these factors on key diseases and the related medical care costs of each disease. The indirect costs on reduced disability, mortality and sickness during the period of active labour force participation prior to retirement are also examined. A case study is prepared for China to provide some guidance in the utilization of this review for economic analysis of obesity. The case study shows that the indirect costs are often far more important than the direct medical care costs. The Chinese case study found that the indirect effects of obesity and obesity-related dietary and physical activity patterns range between 3.58% and 8.73% of gross national product (GNP) in 2000 and 2025 respectively.

Abstract

This study examines changes in cancer-related health behaviors and risk factors (overweight/obesity, unhealthy diet, high alcohol use, and smoking), and screening practices related to cervical, breast, and colorectal cancer among Latinos of predominantly Mexican origin in Monterey County, California.Data is from two cross-sectional surveys, conducted in 1990 and 2000, that included 919 women and 774 men from a community sample, and 276 men from an agricultural labor camp sample (ages 18-64).Over the 10-year period, the prevalence of obesity increased by 48% among community women, 47% among community men, and 91% among labor camp men. Although consumption of fruits and vegetables remained low and consumption of fried foods remained high, other diet-related behaviors showed significant improvements (e.g. milk consumption shifted from whole-fat to lower-fat among women from the community and men from the labor camps, use of lard or meat fat when cooking decreased among women and men from the community). In addition, alcohol intake decreased among men from both samples, as did smoking among labor camp men. There were large improvements for annual pap and mammography screening (increases from 53 to 71% for pap testing, and from 15 to 53% for mammography screening) but annual blood stool testing remained infrequent and unchanged.These findings highlight the need for interventions and policies that improve knowledge, preventive care, and social environments to sustain improvements and address areas of special need in cancer prevention for Latinos, especially related to obesity and colorectal screening.

Abstract

Extensive studies have revealed the importance of a healthy lifestyle and the role of each lifestyle factor in health. However, lifestyle factors have rarely been studied simultaneously. The authors propose an integrated approach to summarize total healthfulness of lifestyles and to enhance understanding of lifestyle patterns across countries.The authors created an overall measure of lifestyle called the Lifestyle Index (LI), integrating diet, physical activity, smoking, and alcohol use to provide a global tool of monitoring healthfulness and patterns of lifestyles. Using the LI, the authors conducted a cross-national comparison between China (n = 8352) and the United States (n = 9750).The LI effectively reflected the healthfulness of lifestyle components in both countries. The mean of the LI scores was slightly higher in China than the US. Scores of diet quality, physical activity, and smoking were higher in China, but scores of alcohol behavior were higher in the US. Similar lifestyle patterns but different unhealthy behaviors were identified in these countries.An assessment of total healthfulness of lifestyles and a better understanding of lifestyle patterns across countries using the LI can provide practical guidance to developing and targeting public health promotion activities to improve global public health.

Abstract

Health disparity by socioeconomic status has recently become an important public health concern. Socioeconomic status may affect health status through several pathways including lifestyle choices. The authors tested the link between socioeconomic status and lifestyle in China (in 1993) and in the United States (in 1994-1996), countries with high contrasts in development, to understand health discrepancy issues cross-nationally. Healthfulness of lifestyle was measured using the Lifestyle Index, a summary score that integrates four key lifestyle factors: diet, physical activity, smoking, and alcohol consumption. Income and education were used as indicators of socioeconomic status. In China, as socioeconomic status improved, lifestyle was less healthy (relative odds for the highest socioeconomic status group = 0.19, 95% confidence interval: 0.10, 0.35). Conversely, in the United States, higher socioeconomic status was related to a healthier lifestyle (relative odds for the highest socioeconomic status group = 3.81, 95% confidence interval: 2.94, 4.94). The contrasting relation between socioeconomic status and lifestyle depicts different phases of the lifestyle transition (changes in lifestyles accompanying economic development). The differences may in part explain why nutrition-related noncommunicable diseases are more prevalent in the developing world among people with a high socioeconomic status, whereas often the opposite is found in developed societies. Public health programs may benefit by advising each socioeconomic status group separately, while considering the country's level of development.

Abstract

A composite measure of diet has been preferred to an index of a single nutrient or food in the area of dietary assessment. However, the lack of such a tool for cross-national comparisons has restricted the ability to compare diet quality between countries using an overall measure of diet. In this study, we created a tool called the Diet Quality Index-International (DQI-I) for global monitoring and exploration of diet quality across countries. The major categories of the index components are variety, adequacy, moderation and overall balance. Using the tool, this research presents a cross-national comparison of diet quality between China and the United States, incorporating comparable national in-depth diet data. The mean of the DQI-I score was slightly higher in China than in the United States. By major categories of the DQI-I, dietary variety was better achieved in the U.S. diet; moderation and overall balance of intakes were better accomplished in China. The DQI-I was successful in capturing variability in intakes of food and nutrients in both countries. Some distinct patterns of poor quality diet in each country were also identified. As demonstrated in this study, the DQI-I provides an effective means of cross-national comparative work for global understanding of diet quality. Furthermore, the dietary problem areas identified by the DQI-I may be useful in guiding the development of programs to improve public health.

The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional dietBellagio Conference on the Nutrition Transition and Its Implications for Health in the Developing WorldLee, M. J., Popkin, B. M., Kim, S.CAMBRIDGE UNIV PRESS.2002: 197–203

Abstract

The purposes of this paper are to describe the unique aspects of the nutrition transition in South Korea, including trends in food consumption and obesity, patterns of morbidity and mortality; to focus on efforts to maintain the traditional diet in the midst of rapid economic growth and the introduction of Western culture; and to provide insights for other countries.We analysed secondary dietary intake, anthropometric, morbidity and mortality data from published reports and articles.In South Korea, the level and rate of increase in fat intake have remained very low, whereas vegetable intake has been high and fruit intake has increased greatly. South Korea also has a relatively low prevalence of obesity compared with other Asian countries. The traditional Korean diet is a low-fat and high-vegetable diet. Therefore, the government and nutrition specialists have been initiating numerous efforts to advertise and teach the public that the traditional diet is a healthy diet. They are also working on revival of the traditional diet using an approach that is acceptable to contemporary Koreans.The nutrition transition in South Korea is unique. A range of government, nutrition specialists and some private organisation efforts has worked to retain healthful elements of the traditional diet in South Korea. The continued low level of total fat in the overall diet and the high intake of fruits and vegetables bode well for South Korea.

Abstract

Undernutrition is being rapidly reduced in India and China. In both countries the diet is shifting toward higher fat and lower carbohydrate content. Distinct features are high intakes of foods from animal sources and edible oils in China, and high intakes of dairy and added sugar in India. The proportion of overweight is increasing very rapidly in China among all adults; in India the shift is most pronounced among urban residents and high-income rural residents. Hypertension and stroke are relatively higher in China and adult-onset diabetes is relatively higher in India. Established economic techniques were used to measure and project the costs of undernutrition and diet-related noncommunicable diseases in 1995 and 2025. Current WHO mortality projections of diet-related noncommunicable diseases, dietary and body composition survey data, and national data sets of hospital costs for healthcare, are used for the economic analyses. In 1995, China's costs of undernutrition and costs of diet-related noncommunicable diseases were of similar magnitude, but there will be a rapid increase in the costs and prevalence of diet-related noncommunicable diseases by 2025. By contrast with China, India's costs of undernutrition will continue to decline, but undernutrition costs did surpass overnutrition diet-related noncommunicable disease costs in 1995. India's rapid increase in diet-related noncommunicable diseases and their costs projects similar economic costs of undernutrition and overnutrition by 2025.

Abstract

An accelerating shift from infectious to noncommunicable diseases and concurrent shifts in diet, activity, and body composition are universal trends but are especially apparent in middle- and lower-income countries. A unique nutrition transition has occurred in South Korea, a country that modernized earlier than most Asian countries did.The purpose of this analysis was to describe the South Korean nutrition transition, focusing on specific features that other countries might follow to retain the healthful elements of their traditional diets.We used secondary data on economics, dietary intake, anthropometry, and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey).The structure of South Korea's economy, along with the country's dietary and disease patterns, began an accelerated shift in the 1970s. Major dietary changes included a large increase in the consumption of animal food products and a fall in total cereal intake. Uniquely, the amount and rate of increase in fat intake have remained low in South Korea. South Korea also has a relatively low prevalence of obesity compared with other Asian countries with similar or much lower incomes.The nutrition transition in South Korea is unique. National efforts to retain elements of the traditional diet are thought to have shaped this transition in South Korea in the midst of rapid economic growth and the introduction of Western culture.